| NPI | 1548074511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1191819) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 152459) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 152459) | |
| Enumeration Date | 2025-02-01 |
| Last Update Date | 2025-05-02 |